Evidence Table for Assessment of Risk of Bias and Quality: KQ12 Randomized Control Trials (RCTs)
Reference number
Quality items
1 2 3 4 5 6 7 LOE
RCT1 L L L L L L H 1+
RCT2 L L H H L L L 1+
1. Random sequence generation: selection bias (biased allocation to interventions) due to inadequate generation of a randomized. 2. Allocation concealment: selection bias (biased allocation to interventions) due to inadequate conceal-ment of allocations prior to assignconceal-ment. 3. Blinding of participants and personnel: performance bias due to knowledge of the allocated interventions by participants and personnel during the study. 4. Blinding of outcome assessment:
detection bias due to knowledge of the allocated interventions by outcome assessors. 5. Incomplete outcome data: at-trition bias due to amount, nature or handling of incomplete outcome data. 6. Selective reporting: reporting bias due to selective outcome reporting. 7. Other bias: bias due to problems not covered elsewhere in the table.
L, low risk of bias; H, high risk of bias; U, unclear risk of bias.
#16 ((interval or aerobic) near (train* or exercise* or run* or fitness)):ti,ab,kw
#17 ((muscle* or resistan*) near (train* or activ* or strength* or exercise*)):ti,ab,kw
#18 {or #11-#17}
#19 #10 and #18
The following is the specific searching strategy for KQ13-3, “CABG + Stretching”:
#11 MeSH descriptor: [Range of Motion, Articular] explode all trees
#12 (stretch* or flexibilit*):ti,ab,kw
#13 #11 or #12
#14 #10 and #13
The following is the specific searching strategy for KQ13-4, “CABG + Respiration training”:
#11 (respirat* or inspirat*) near (train* or educat* or exercise* or physiotherap*):ti,ab,kw
#12 spiromet*:ti,ab,kw
#13 #11 or #12
#14 #10 and #13
The following is the specific searching strategy for KQ13-5. “CABG + Dysphagia”:
#11 MeSH descriptor: [Deglutition Disorders] explode all trees
#12 (dysphagia or (swallow* near (difficult* or disorder))):ti,ab,kw
#13 #11 or #12
#14 #10 and #13
Flow Chart of Study Selection Process
Records identified through database searching Cochrane (6), Embase (67), PubMed (48)
Total (n=103)
Records after duplicates removed (n=92)
Records screened on basis of title and abstract (n=92)
Full-text articles accessed for eligibility (n=16)
Studies included in qualitative synthesis (n=1)
Records excluded (n=77)
1 paper added among other key question database searching
Full-text articles excluded, with reasons (n=15)
1. The patient does not have acute coronary syndrome (n=1) 2. Literatures irrelevant to the key question (n=8)
3. Non-human studies (animal study or preclinical studies) (n=0) 4. Literatures published in languages other than English or Korean (n=0) 5. Duplicate publication (n=2)
6. Full text unavailable (n=1) 7. Other (n=3)
Finally Included Studies Reference
number Article
SR1 Aldahash R, Al Dera HS. Physical therapy program improves the physiological impact towards better quality of life and low cardiac risk factors in patients following coronary artery bypass grafting: system-atic review. Acta Medica Int 2016;3:185-95.
SR, systematic reviews.
Evidence Table for Assessment of Risk of Bias and Quality
Methodological Quality of Systematic Reviews using AMSTAR 2.0 and Level of Evidence (LOE) using SIGN Methods Reference
number
Quality items
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 LOE
SR1 Y N Y P N N N P N N N M M N M Y 1–
1. Did the research questions and inclusion criteria for the review include the components of PICO? 2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? 3. Did the review authors explain their selec-tion of the study designs for inclusion in the review? 4. Did the review authors use a comprehensive literature search strategy? 5. Did the review authors perform study selection in duplicate? 6. Did the review authors perform data ex-traction in duplicate? 7. Did the review authors provide a list of excluded studies and justify the exclusions? 8. Did the review authors describe the included studies in adequate detail? 9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? 10. Did the review authors report on the sources of funding for the studies included in the review? 11. If meta-analysis was performed did the re-view authors use appropriate methods for statistical combination of results? 12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? 13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? 14. Did the review authors provide a satisfactory explanation for, and discussion of, any het-erogeneity observed in the results of the review? 15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? 16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
Y, yes; N, no; P, partial yes; M, no meta-analysis conducted.
Methodological Quality of Systematic Reviews using GRADE and Level of Evidence (LOE) using SIGN Methods Reference
number 1 2 3 4 5 6 7 8 GRADE LOE
SR1 –1 –1 –1 Very low (1) 1–
1. Limitation, 2. Inconsistency, 3. Indirectness, 4. Imprecision, 5. Publication bias, 6. Large magnitude effect, 7. All plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results show no effect, 8.
Dose response gradient.
The following is the basic searching strategy used for cardiac rehabilitation treatment (KQ 14-18) in the Cochrane Li-brary, combined with the specific searching strategy for each question using AND.
#1 MeSH descriptor: [Myocardial Ischemia] explode all trees
#2 ((myocard* or heart* or coronary or cardia*) and (infarct* or isch* or attack*)):ti,ab,kw
#3 (“acute coronary syndrome” or ACS):ti,ab,kw
#4 (angina or stenocardia*):ti,ab,kw
#5 {or #1-#4}
#6 MeSH descriptor: [Myocardial Revascularization] explode all trees
#7 ((Myocard* or cardi* or coronary) and (Revascular* or angioplast*)):ti,ab,kw
#8 ((coronary or rotational) near atherectom*):ti,ab,kw
#9 MeSH descriptor: [Percutaneous Coronary Intervention] explode all trees
#10 (“percutaneous coronary intervention*” or PCI):ti,ab,kw
#11 (percutaneous next coronary near/2 (interven* or revascular*)):ti,ab,kw
#12 (stent* and (heart or cardiac*)):ti,ab,kw
#13 coronary near (disease* or bypass or thrombo* or angioplast*):ti,ab,kw
#14 (PTCA or “percutaneous transluminal coronary angioplasty”):ti,ab,kw
#15 MeSH descriptor: [Cardiac Surgical Procedures] explode all trees
#16 (“coronary artery bypass” or “CABG” or “aortocoronary bypass” or “coronary bypass”):ti,ab,kw
#17 (“coronary” near “arter*” near “bypass”):ti,ab,kw
#18 {or #6-#17}
#19 #5 and #18
The same Cochrane Library searching strategy was used for KQ14 (“Should aerobic exercise be included in the car-diac rehabilitation program?”) and KQ15 (“Should resistance (muscle training) exercise be included in the carcar-diac re-habilitation program?”) The following is the final searching strategy, including the basic searching strategy for exercise therapy for CR:
Searching Strategies
#20 MeSH descriptor: [Exercise] explode all trees
#21 MeSH descriptor: [Exercise Therapy] explode all trees
#22 ((“exercise*” or “train*” or fitness) and (“strength*” or “aerobic”)):ti,ab,kw
#23 (physical near (train* or activ*)):ti,ab,kw
#24 ((physio or physic* or kinesio*) near therap*):ti,ab,kw
#25 ((interval or aerobic) near (train* or exercise* or run* or fitness)):ti,ab,kw
#26 ((muscle* or resistan*) near (train* or activ* or strength* or exercise*)):ti,ab,kw
#27 {or #20-#26}
#28 #19 and #27
Finally Included Studies: KQ14 Reference
number Article
SR1 Chen YC, Tsai JC, Liou YM, Chan P. Effectiveness of endurance exercise training in patients with coronary artery disease: a meta-analysis of randomised controlled trials. Eur J Cardiovasc Nurs 2017;16:397-408.
SR2 Liou K, Ho S, Fildes J, Ooi SY. High intensity interval versus moderate intensity continuous training in patients with coronary artery disease: a meta-analysis of physiological and clinical parameters. Heart Lung Circ 2016;25:166-74.
SR, systematic reviews.
Flow Chart of Study Selection Process: KQ14
Records identified through database searching Cochrane (37), Embase (70), PubMed (156)
Total (n=263)
Records after duplicates removed (n=249)
Records screened on basis of title and abstract (n=249)
Full-text articles accessed for eligibility (n=72)
Studies included in qualitative synthesis (n=2)
Records excluded (n=177)
Full-text articles excluded, with reasons (n=70)
1. The patient does not have acute coronary syndrome (n=5) 2. Literatures irrelevant to the key question (n=37)
3. Non-human studies (animal study or preclinical studies) (n=1) 4. Literatures published in languages other than English or Korean (n=0) 5. Duplicate publication (n=6)
6. Full text unavailable (n=9) 7. Other (n=12, not SR, etc.)
Evidence Table for Assessment of Risk of Bias and Quality: KQ14 Systematic Reviews (SR)
Reference number
Quality items
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 LOE
SR1 Y Y Y Y Y Y N P Y N Y Y Y Y Y Y 1–
SR2 Y Y Y Y N N N Y Y N Y Y Y N Y N 1+
1. Did the research questions and inclusion criteria for the review include the components of PICO? 2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? 3. Did the review authors explain their selec-tion of the study designs for inclusion in the review? 4. Did the review authors use a comprehensive literature search strategy? 5. Did the review authors perform study selection in duplicate? 6. Did the review authors perform data ex-traction in duplicate? 7. Did the review authors provide a list of excluded studies and justify the exclusions? 8. Did the review authors describe the included studies in adequate detail? 9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? 10. Did the review authors report on the sources of funding for the studies included in the review? 11. If meta-analysis was performed did the re-view authors use appropriate methods for statistical combination of results? 12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? 13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? 14. Did the review authors provide a satisfactory explanation for, and discussion of, any het-erogeneity observed in the results of the review? 15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? 16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
Y, yes; N, no; P, partial yes.
Methodological Quality of Systematic Reviews using GRADE and Level of Evidence (LOE) using SIGN Methods Reference
number 1 2 3 4 5 6 7 8 GRADE LOE
SR1 –1 –1 Very low (1) 1–
SR2 –1 Moderate (3) 1+
1. Limitation, 2. Inconsistency, 3. Indirectness, 4. Imprecision, 5. Publication Bias, 6. Large magnitude effect, 7. All plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results show no effect, 8.
Dose response gradient.
Finally Included Studies: KQ15 Reference
number Article
SR1 Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aero-bic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2017;24:1242-59.
SR2 Karagiannis C, Savva C, Mamais I, Efstathiou M, Monticone M, Xanthos T. Eccentric exercise in ischemic cardiac patients and functional capacity: a systematic review and meta-analysis of randomized con-trolled trials. Ann Phys Rehabil Med 2017;60:58-64.
SR3 Xanthos PD, Gordon BA, Kingsley MI. Implementing resistance training in the rehabilitation of coronary heart disease: a systematic review and meta-analysis. Int J Cardiol 2017;230:493-508.
SR, systematic reviews.
Flow Chart of Study Selection Process: KQ15
Records identified through database searching Cochrane (37), Embase (70), PubMed (156)
Total (n=263)
Records after duplicates removed (n=249)
Records screened on basis of title and abstract (n=249)
Full-text articles accessed for eligibility (n=72)
Studies included in qualitative synthesis (n=3)
Records excluded (n=177)
Full-text articles excluded, with reasons (n=69)
1. The patient does not have acute coronary syndrome (n=5) 2. Literatures irrelevant to the key question (n=36)
3. Non-human studies (animal study or preclinical studies) (n=1) 4. Literatures published in languages other than English or Korean (n=0) 5. Duplicate publication (n=6)
6. Full text unavailable (n=9)
7. Other (n=12, same clinical trials cited in other SR, etc.)
Evidence Table for Assessment of Risk of Bias and Quality: KQ15 Systematic Reviews (SR)
Reference number
Quality items
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 LOE
SR1 Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y 1–
SR2 Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y 1–
SR3 Y Y N N Y Y Y P Y Y Y Y Y Y Y Y 1+
1. Did the research questions and inclusion criteria for the review include the components of PICO? 2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? 3. Did the review authors explain their selec-tion of the study designs for inclusion in the review? 4. Did the review authors use a comprehensive literature search strategy? 5. Did the review authors perform study selection in duplicate? 6. Did the review authors perform data ex-traction in duplicate? 7. Did the review authors provide a list of excluded studies and justify the exclusions? 8. Did the review authors describe the included studies in adequate detail? 9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? 10. Did the review authors report on the sources of funding for the studies included in the review? 11. If meta-analysis was performed did the re-view authors use appropriate methods for statistical combination of results? 12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? 13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? 14. Did the review authors provide a satisfactory explanation for, and discussion of, any het-erogeneity observed in the results of the review? 15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? 16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
Y, yes; N, no; P, partial yes.
Methodological Quality of Systematic Reviews using GRADE and Level of Evidence (LOE) using SIGN Methods Reference
number 1 2 3 4 5 6 7 8 GRADE LOE
SR1 –2 –1 –1 +1 Very low (1) 1–
SR2 –1 –1 –1 Very low (1) 1–
SR3 –1 Moderate (3) 1+
1. Limitation, 2. Inconsistency, 3. Indirectness, 4. Imprecision, 5. Publication Bias, 6. Large magnitude effect, 7. All plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results show no effect, 8.
Dose response gradient.
The following is the final Cochrane Library searching strategy used for KQ16 (“How can the safety of cardiac rehabili-tation exercise be enhanced?”) including the basic searching strategy for exercise therapy for CR:
Searching Strategies
#20 MeSH descriptor: [Cardiac Rehabilitation] explode all trees
#21 ((*cardia* or heart*) and *habilitation*):ti,ab,kw
#22 {or #20-#21}
#23 MeSH descriptor: [Wireless Technology] explode all trees
#24 MeSH descriptor: [Electrocardiography] explode all trees
#25 ((electrocardiography or ecg or ekg) near monitor*):ti,ab,kw
#26 MeSH descriptor: [Safety] explode all trees
#27 (safe* or risk):ti,ab,kw
#28 {or #23-#27}
#29 #19 and #22 and #28
Finally Included Studies
Reference number Article
-
-The following is the final Cochrane Library searching strategy used for KQ17 (“Can a home-based cardiac rehabili-tation program replace a hospital-based cardiac rehabilirehabili-tation program?”) including the basic searching strategy for exercise therapy for CR:
Searching Strategies
#20 MeSH descriptor: [Cardiac Rehabilitation] explode all trees
#21 ((*cardia* or heart*) and *habilitation*):ti,ab,kw
#22 MeSH descriptor: [Rehabilitation] explode all trees
#23 (rehabilitat* or *habilitation):ti,ab,kw
#24 MeSH descriptor: [Physical and Rehabilitation Medicine] explode all trees
#25 MeSH descriptor: [Health Facilities] explode all trees
#26 MeSH descriptor: [Rehabilitation Nursing] explode all trees
#27 {or #20-#26}
#28 (home or center or centre):ti,ab,kw
#29 #19 and #27 and #28
Flow Chart of Study Selection Process
Records identified through database searching Cochrane (37), Embase (70), PubMed (156)
Total (n=263)
Records after duplicates removed (n=85)
Records screened on basis of title and abstract (n=85)
Full-text articles accessed for eligibility (n=52)
Studies included in qualitative synthesis (n=0)
Records excluded (n=33)
Full-text articles excluded, with reasons (n=52)
1. The patient does not have acute coronary syndrome (n=1) 2. Literatures irrelevant to the key question (n=33)
3. Non-human studies (animal study or preclinical studies) (n=0) 4. Literatures published in languages other than English or Korean (n=0) 5. Duplicate publication (n=7)
6. Full text unavailable (n=6) 7. Other (n=5)
Finally Included Studies Reference
number Article
SR1 Claes J, Buys R, Budts W, Smart N, Cornelissen VA. Longer-term effects of home-based exercise interven-tions on exercise capacity and physical activity in coronary artery disease patients: a systematic review and meta-analysis. Eur J Prev Cardiol 2017;24:244-56.
SR2 Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, et al. Home-based versus centre-based car-diac rehabilitation. Cochrane Database Syst Rev 2017;6:CD007130.
SR3 Huang K, Liu W, He D, Huang B, Xiao D, Peng Y, et al. Telehealth interventions versus center-based car-diac rehabilitation of coronary artery disease: a systematic review and meta-analysis. Eur J Prev Cardiol 2015;22:959-71.
SR4 McClure T, Haykowsky MJ, Schopflocher D, Hsu ZY, Clark AM. Home-based secondary prevention pro-grams for patients with coronary artery disease: a meta-analysis of effects on anxiety. J Cardiopulm Re-habil Prev 2013;33:59-67.
SR, systematic reviews.
Flow Chart of Study Selection Process
Records identified through database searching Cochrane (12), Embase (41), PubMed (28)
Total (n=81)
Records after duplicates removed (n=68)
Records screened on basis of title and abstract (n=68)
Full-text articles accessed for eligibility (n=25)
Studies included in qualitative synthesis (n=4)
Records excluded (n=43)
Full-text articles excluded, with reasons (n=21)
1. The patient does not have acute coronary syndrome (n=1) 2. Literatures irrelevant to the key question (n=10)
3. Non-human studies (animal study or preclinical studies) (n=0) 4. Literatures published in languages other than English or Korean (n=0) 5. Duplicate publication (n=6)
6. Full text unavailable (n=0) 7. Other (n=4, not meta-analysis)
Evidence Table for Assessment of Risk of Bias and Quality: KQ17 Reference
number
Quality items
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 LOE
SR1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1–
SR2 Y Y Y Y Y Y Y Y Y N N N N N N N 1+
SR3 Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y 1–
SR4 Y Y Y P Y P P Y Y N Y Y Y Y Y N 1–
1. Did the research questions and inclusion criteria for the review include the components of PICO? 2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? 3. Did the review authors explain their selec-tion of the study designs for inclusion in the review? 4. Did the review authors use a comprehensive literature search strategy? 5. Did the review authors perform study selection in duplicate? 6. Did the review authors perform data ex-traction in duplicate? 7. Did the review authors provide a list of excluded studies and justify the exclusions? 8. Did the review authors describe the included studies in adequate detail? 9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? 10. Did the review authors report on the sources of funding for the studies included in the review? 11. If meta-analysis was performed did the re-view authors use appropriate methods for statistical combination of results? 12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? 13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? 14. Did the review authors provide a satisfactory explanation for, and discussion of, any het-erogeneity observed in the results of the review? 15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? 16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
Y, yes; N, no; P, partial yes.
Methodological Quality of Systematic Reviews using GRADE and Level of Evidence (LOE) using SIGN Methods Reference
number 1 2 3 4 5 6 7 8 GRADE LOE
SR1 –1 –1 Low (2) 1–
SR2 –1 –1 +1 Moderate (3) 1+
SR3 –1 –1 Low (2) 1–
SR4 –1 –1 –1 Very low (1) 1–
1. Limitation, 2. Inconsistency, 3. Indirectness, 4. Imprecision, 5. Publication Bias, 6. Large magnitude effect, 7. All plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results show no effect, 8.
Dose response gradient.
The following is the final Cochrane Library searching strategy used for KQ18 (“Should cardiac rehabilitation pro-grams be recommended to elderly patients?”) including the basic searching strategy for exercise therapy for CR:
Searching Strategies
MeSH descriptor: [Cardiac Rehabilitation] explode all trees
#21 ((*cardia* or heart*) and *habilitation*):ti,ab,kw
#22 MeSH descriptor: [Rehabilitation] explode all trees
#23 (rehabilitat* or *habilitation):ti,ab,kw
#24 MeSH descriptor: [Physical and Rehabilitation Medicine] explode all trees
#25 MeSH descriptor: [Health Facilities] explode all trees
#26 MeSH descriptor: [Rehabilitation Nursing] explode all trees
#27 {or #20-#26}
#28 MeSH descriptor: [Women] explode all trees
#29 MeSH descriptor: [Aged] explode all trees
#30 (women or woman or female or gender):ti,ab,kw
#31 (old* or elder* or aged):ti,ab,kw
#32 {or #28-#31}
#33 #19 and #27 and #32
Finally Included Studies Reference
number Article
SR1 Yamamoto S, Hotta K, Ota E, Mori R, Matsunaga A. Effects of resistance training on muscle strength, ex-ercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: a meta-analysis. J Cardiol 2016;68:125-34.
SR, systematic reviews.
Flow Chart of Study Selection Process
Records identified through database searching Cochrane (21), Embase (76), PubMed (22)
Total (n=119)
Records after duplicates removed (n=113)
Records screened on basis of title and abstract (n=113)
Full-text articles accessed for eligibility (n=29)
Studies included in qualitative synthesis (n=1)
Records excluded (n=84)
Full-text articles excluded, with reasons (n=28)
1. The patient does not have acute coronary syndrome (n=0) 2. Literatures irrelevant to the key question (n=17)
3. Non-human studies (animal study or preclinical studies) (n=0) 4. Literatures published in languages other than English or Korean (n=0) 5. Duplicate publication (n=4)
6. Full text unavailable (n=4)
7. Other (n=3, same clinical trials cited in other SR)
Evidence Table for Assessment of Risk of Bias and Quality
Methodological Quality of Systematic Reviews using AMSTAR 2.0 and Level of Evidence (LOE) using SIGN Methods Reference
number
Quality items
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 LOE
SR1 Y Y Y Y Y Y P Y Y N Y Y Y Y Y Y 1++
1. Did the research questions and inclusion criteria for the review include the components of PICO? 2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? 3. Did the review authors explain their selec-tion of the study designs for inclusion in the review? 4. Did the review authors use a comprehensive literature search strategy? 5. Did the review authors perform study selection in duplicate? 6. Did the review authors perform data ex-traction in duplicate? 7. Did the review authors provide a list of excluded studies and justify the exclusions? 8. Did the review authors describe the included studies in adequate detail? 9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? 10. Did the review authors report on the sources of funding for the studies included in the review? 11. If meta-analysis was performed did the re-view authors use appropriate methods for statistical combination of results? 12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? 13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? 14. Did the review authors provide a satisfactory explanation for, and discussion of, any het-erogeneity observed in the results of the review? 15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? 16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
Y, yes; N, no; P, partial yes.
Methodological Quality of Systematic Reviews using GRADE and Level of Evidence (LOE) using SIGN Methods Reference
number 1 2 3 4 5 6 7 8 GRADE LOE
SR1 High (4) 1++
1. Limitation, 2. Inconsistency, 3. Indirectness, 4. Imprecision, 5. Publication Bias, 6. Large magnitude effect, 7. All plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results show no effect, 8.
Dose response gradient.